Haryana

Karnal

528/12

Smt. Jasbir kaur - Complainant(s)

Versus

Life Insurance Corporation Of India - Opp.Party(s)

Sh. L. D. Kamboj

28 Mar 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.  

                                                          Complaint No. No.527 of 2012

                                                               Date of instt.: 6.11.2012

                                                          Date of decision:28 .03.2016

Smt.Jasbir  Kaur wife of late Sh.Baljinder Singh son of Sh.Balkar Singh resident of 132 KV Sub Station, Power House colony, Indri at present resident of near Dera Sacha Saudha, Pal Colony, Indri District Karnal.                                              ……..Complainant. .

                                      Vs.

Life Insurance Corporation of India, through its Divisional Manager, Divisional Office, P.O.Box No.106, Jivan Parkash, 489, Model Town, Karnal.

.

                                                                           ……… Opposite Party.

                     Complaint u/s 12  of the Consumer

                     Protection Act.

Before          Sh.K.C.Sharma……….President.                

                   Sh.Anil Sharma…….Member.

 

Present:-        Sh.L.D. Kamboj Advocate for the complainant.

                    Sh.N.K.Zak Advocate for the Opposite Party..

ORDER:                    

                       

                        This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986, on the averments that her husband  Baljinder Singh  (the deceased life assured) had purchased life insurance policy  No. 171722570 under the T &T 106/15/12 from the  Opposite Party. The said policy was to commence from 15.2.1999 and the sum assured was Rs.50,000/-. He was 6th class pass and employed with Government as driver in UHBVNL.  He was having very good health at the time of obtaining the policy and before or at the time of revival of the policy. He was also  medically examined by the doctors of the Opposite Party before issuance of the policy as well as before revival of the policy and found to be healthy. In the month of October 2010, he suddenly fell ill and died on 29.10.2010, while admitted in Amritdhara Hospital, Karnal. After his death,  she being his nominee lodged claim with the Opposite Party for seeking benefits under the policy and submitted all the requisite documents. However, the Opposite Party, vide letter dated 7.11.2011, wrongly and illegally repudiated her claim  on the false pretext that life assured had concealed necessary information regarding his state of health at the time of revival of the policy. Thereafter, she gave representation to the Divisional Manager, but order of repudiation was not revised and her request was turned down.  However, the Opposite Party gave benefits of two other policies as mentioned in para no.8 of the complaint. The act of repudiation of the claim by the Opposite Party amounted to deficiency in services, which caused her mental pain and agony apart from financial loss.

 

2.       Notice of the complaint was given to the Opposite Party, who appeared and filed written statement disputing the claim of the complainant. Objections have been raised that the complaint is not maintainable in the present form; that the complainant has no locus standi and cause of action to file the complaint; that the complainant is estopped by her own acts and conduct from filing the present complaint; that this Forum has no jurisdiction to  entertain and decide the present complaint; that the complainant has not approached this Forum with clean hands and that the complaint is false, frivolous and vexacious to the knowledge of the complainant and the same is misuse of the process of law.

 

                   On merits, it has been admitted that deceased life assured had obtained life insurance policy, which was to commence from 15.2.1999 and had  appointed the complainant as his nominee. However, it has been submitted that  the deceased life assured failed to make payment of the premium regularly and the policy  was renewed on 6.3.2009 on the basis of declaration  of good health submitted by him. Revival of the policy is a Denovo contract.  As the life assured had died on 29.10.2010 i.e. approximately after one and half year from the date of revival of the policy, investigation was conducted to verify the contents  of the death  intimation. It was transpired that life assured had suffered from the disease of diabetic foot for which he had taken treatment from  Haryana Nursing Home, Sector 14, Karnal and remained admitted there from 24.7.2008 to 25.7.2008. Fitness certificate was issued by Aggarwal Nursing Home, Kurukshetra. The  life assured had obtained leave from his place of working  on medical ground from  23.7.2008 to 31.8.2008. However, the life assured malafidely and intentionally concealed the material information regarding his health, which he was morally and legally bound to disclose while submitting the proposal form, because the contract of insurance is based on  principle of uberrima-fide. Therefore, the claim lodged by the complainant was rightly repudiated, vide speaking order dated 7.4.2011.

 

3.                In evidence of the complainant, her affidavit Ex.C1 and documents Ex.C2 to Ex.C7 have been tendered.

 

4.                On the other hand, in evidence of the Opposite Party, affidavit of P.K.Saxena, Manager Legal,Ex.O1 and documents Ex.O2 to Ex.O10 have been tendered.

 

5.                We have appraised the evidence on record,  the material circumstances of the case and the arguments advanced by the learned Counsel for the parties.

 

6.                It is the admitted fact that Baljinder Singh , the deceased life assured, was insured by the Opposite Party vide insurance policy No. 171722570 under the T &T 106/15/12, which was to commence from 15.2.1999. He died on 29.10.2010. The complainant being the nominee of the life assured lodged the claim with the Opposite Party, but the same was repudiated, vide order dated 7.4.2011.  As per the case of the Opposite Party, the deceased life assured failed to make the payment of the premiums regularly and the policy was revived on 6.3.2009 on the basis of declaration of good health submitted by him. He concealed the material information regarding his health in the revival  form that he was suffering from diabetic foot for which  he remained on medical leave from 23.7.2008 to 31.8.2008 and got treatment from Haryana Nursing Home, Karnal and Aggarwal Nursing Home, Kurukshetra.

 

7.                The learned counsel for the complainant put a great thrust upon the contention that life assured was duly examined by the medical officer of the Opposite Party before issuance of the policy as well as before revival of the policy. The proposal form and revival form were  filled by the agent of the Opposite Party to whom all the necessary facts regarding his health were disclosed, but he intentionally did not mention those facts in the proposal form/revival form. Therefore, the complainant cannot be denied the benefits under the policy on such ground.

 

8.                It is settled principle of insurance law that contract of insurance is a contract uberrima fide and utmost  faith must be observed by the contracting parties. Every material fact must be disclosed, otherwise, there is good ground for rescission of contract. If, there are mis statements or suppression of material facts, the  policy can be called into question.  Concealment of previous ailments is suppression of material facts and the complainant is not entitled for compensation.  In this context, reference may be made to the  judgment of Hon’ble Supreme Court in case Satwant Kaur Sandhu Vs.New India Assurance Co.  IV (2009) CPJ 8 (SC).   The Hon’ble National Commission in case Life Insurance Corporation of India and another Versus Bimla Devi , revision petition No.3806 of 2009 , decided on 12.8.2015 also considered various judgments and principle of law laid down therein and observed that any fact which would influence the mind of prudent insurer in deciding whether  to accept or not to accept the risk is material fact.  If, the proposer has knowledge of such fact, he is obliged to disclose it particular while answering the questions in the proposal form.   Needless to emphasise that any inaccurate answer will entitle the insurer to repudiate his liability, because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a Contract of Insurance.

 

9.                The facts of the present case are to be analyzed keeping in view the aforesaid proposition of law. Copy of the revival form is Ex.O10, which was submitted by the life assured on 6.3.2009. In para no.2 of the said revival form following four questions were put to him.

i)        Whether he suffered from any ailment?

ii)       Whether he suffered from such ailment for which he required treatment for a period of more than one week?

iii)      Whether any surgery was performed and whether he met with any accident or suffered injury; and

iv)      Whether he got himself examined for electrocardiogram, x-ray or screening, blood, urine or stool.

 

                   He gave answers to all these questions in negative. Thus, it is emphatically clear that the  life assured did not disclose about any ailment suffered by him prior to submission of the revival form.

 

10.               The Opposite Party has produced documents Ex.O2 to Ex.O9 which are sufficient to establish that the  life  assured remained admitted in Haryana Nursing Home, Karnal from 23.7.2008 to 28.7.2008 and thereafter in Aggarwal Nursing Home, Kurukshetra from 28.7.2008 to 3.8.2008, for getting treatment of his diabetic right foot and  for that purpose he availed medical leave from 23.7.2008 to 31.8.2008 and resumed his duties on 1.09.2008 after obtaining fitness certificate from Aggarwal Nursing Home, Kurukshetra. The policy was got revived by him by submitting the revival form Ex.O10 on 6.3.2009.  However,  in the said form he concealed the fact that he was suffering from diabetic  right foot and remained admitted for treatment for the same in Haryana Nursing Home, Karnal and Aggarwal Nursing Home , Kurukshetra  from 23.7.2008 to 3.8.2008 and remained on medical leave  from 23.7.2008 to 31.8.2008. Had he disclosed about the condition of his health at the time of submitting the revival form, that could certainly influence decision of the insurance company to revive or not to revive the insurance policy or as to what amount of premium was to be charged, if the policy was to be revived. The argument of the learned counsel for the complainant that agent of the  Opposite Party, who  filled the revival form did not  mention about the disease of the diabetic right foot, though disclosed by the life assured, cannot be accepted. The revival form Ex.O10 is in Hindi. The life assured also signed the revival form in Hindi, which clearly indicates that he could read Hindi language.  There is no evidence that any medical officer of the Opposite Party examined the life assured before revival of the policy. In fact, the life assured was bound to disclose all the material facts regarding condition of his health in the revival form, but he intentionally concealed about his disease, admission in the hospital from 23.7.2008 to 3.8.2008 and availing medical leave from 23.7.2008 to 31.8.2008 Therefore, the policy became void on account of concealment of material facts by the life assured in the revival form and  in such a situation repudiation of the claim of the complainant by the Opposite Party cannot be considered as illegal or unjustified in any manner.

 

11.               As a sequel to the foregoing discussion, we do not find any merit   in the present complaint. Therefore, the same is hereby dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced
dated:28.03.2016

                                                                (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

            (Anil Sharma ) 

               Member.

 

 

 

 

Present:-        Sh.L.D. Kamboj Advocate for the complainant.

                   Sh.N.K.Zak Advocate for the Opposite parties.

 

                   Arguments heard. Vide our separate order of the even date, the present complaint has been dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:28.03.2016

                                                                (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

            (Anil Sharma ) 

               Member.

 

 

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